Laserfiche WebLink
B-� ign Envelope ID:74A66727-20DF-4329-9253-19EDEA1C9B7F <br />e6 <br />APPLICATION FOR PAYMENT <br />O <br />r T <br />Application No. <br />Project: City of Ramsey Public Works <br />O <br />0 <br />Application Date: <br />19520-0180 <br />Project No.: <br />Contract Date: <br />195200180-312205 <br />Commitment: <br />Contract For: 195200180-312205 - Earthwork <br />a 0 <br />N Y O <br />C .c <br />- am <br />E00i� <br />Q C ;C U <br />c a m <br />Y <br />N U"U-a <br />.a c <br />c 00 <br />30 a > N <br />NO <br />Y N "' � N <br />L O. O o <br />E <br />c O O <br />o 0U4= <br />0 0 <br />Un 0a <br />t N <br />O c > <br />,'mod U <br />o 0 'a - <br />• Tao <br />.0 N C N <br />0a E <br />5 8O T <br />o a) pp. <br />m oy c <br />• �pp N <br />ry) U C a <br />F 0. 0 7 <br />• <Ea <br />a>.�00 <br />3C <br />U .O N <br />2a (° c' <br />2 N C <br />N <br />U o 0 m .0 <br />U <br />a0 <br />C 0 E <br />• o 004- 0 <br />ZU ▪ L U r C <br />7°)c U <br />.0 U U a m <br />0 <br />O <br />0 <br />co <br />0) <br />0) <br />69 <br />1. ORIGINAL CONTRACT AMOUNT • <br />O <br />O <br />O <br />69 <br />2. NET CHANGE BY CHANGE ORDERS <br />O <br />O <br />M <br />co <br />O <br />05 <br />(0 <br />6- <br />3. CONTRACT SUM TO DATE <br />0 <br />O <br />N <br />N <br />co <br />N_ <br />69 <br />4. TOTAL COMPLETED AND STORED TO DATE <br />0 <br />E <br />7 <br />O <br />U <br />0 <br />W <br />5. RETAINAGE <br />4.1 <br />0 <br />C <br />U <br />5.00% of Completed Work <br />0 <br />(0 <br />a <br />Subscribed and sworn to before me this <br />(Columns D + E) <br />5.00% of Stored Materials <br />My commission expires: <br />LL <br />N <br />C <br />E <br />O <br />0 <br />ARCHITECTS CERTIFICATE FOR PAYMENT <br />Total Retainage <br />- (Line 5a + Line 5b OR Sum of Column I) <br />U <br />_p o <br />al (O`p <br />to <br />aQd0 <br />O 0 o 0 HU <br />0 0 <br />c 0 0 <br />C 0A ✓ (0 <br />U)L <br />w c <br />• O N N <br />• N 0 <br />o Y 0 0 <br />N° <br />U <br />0 0. <br />N 0 U 0 <br />c o <br />O 0 z w <br />• 0 <br />30 <br />u = 0 W <br />w U <br />C <br />E .c `o <br />0 <br />8Q5 (0 <br />O1dcn <br />�-a"O <br />• 'O OQ <br />C <br />8 <br />a <br />w � ro may, <br />3 o vE <br />4 <br />Uc '- 0 G N- <br />fl <br />N <br />o EN .p <br />o,ao <br />poy-al a <br />cisEEGo <br />8 `�-o <br />=.�CN <br />6, TOTAL EARNED LESS RETAINAGE <br />(Line 4 less Line 5 Total) <br />O <br />O <br />O <br />63 <br />. LESS PRIOR CERTIFICATES FOR PAYMENT <br />(Line 6 from prior Certificate) <br />8. CURRENT PAYMENT DUE <br />0 <br />h <br />O <br />0) <br />N <br />6▪ 9 <br />9. BALANCE TO FINISH, INCLUDING RETAINAGE <br />11 /10/2020 <br />ARCH <br />(Line 3 less Line 6) <br />w <br />(6 <br />0 <br />m <br />DEDUCTIONS <br />O <br />69 <br />O <br />69 <br />O <br />0 <br />O <br />0 <br />69 <br />(n <br />z <br />0 <br />F- <br />0 <br />0 <br />Q <br />O <br />O <br />O <br />69 <br />0 <br />O <br />O <br />69 <br />O <br />O <br />O <br />6 ' <br />CHANGE ORDER SUMMARY <br />Total changes approved in previous months <br />Total approved this month <br />TOTALS <br />NET CHANGES by Change Orders <br />